Penile cancer is a rare cancer, almost always squamous cell carcinoma, that usually starts on the glans or foreskin. The main risks are an uncircumcised penis with phimosis, poor hygiene, HPV infection, smoking and chronic inflammation such as lichen sclerosus.
Key symptoms
- A sore, lump, wart-like growth or red patch on the glans or foreskin that does not heal
- Bleeding or a bad-smelling discharge under the foreskin
- Lumps in the groin
- Late visits because of embarrassment are common
What you find on exam
- Inspect and measure the lesion, pulling back the foreskin if possible
- Check whether it is fixed to deeper tissue or the shaft
- Feel both groins for enlarged, firm or fixed lymph nodes
- Look for phimosis and lichen sclerosus
Tests
- Biopsy of the lesion to confirm the diagnosis
- MRI or ultrasound of the penis to judge depth
- Groin node assessment: needle aspiration of palpable nodes or sentinel node biopsy
- CT or PET-CT for staging in advanced disease
Treatment basics
- Small superficial lesions: topical imiquimod or fluorouracil, laser or local excision
- Penile-sparing surgery when possible
- Partial or total penectomy for deeper tumors
- Inguinal lymph node dissection when nodes are at risk; cisplatin-based chemotherapy in advanced disease
- Prevention: HPV vaccination, good hygiene, treating phimosis and stopping smoking
Red flags
- A penile sore that does not heal after a few weeks
- Palpable groin lymph nodes
- A bleeding mass or a lesion hidden by a foreskin that will not retract
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.